Archive for August, 2008

Comming (by coincidence) on the heels of my recent blog entry on why I am skeptical of acupuncture, another major acupuncture study has just been published. This study looked at acupuncture for headaches, and was published in a major headache journal – Cephalalgia. The media, in typical fashion, gets the bottom line wrong, declaring: “Acupuncture may ease chronic headache pain.”

It took me about 10 seconds (literally) to realise that this study was utterly worthless. That is because it is unblinded – meaning that both subjects and physicians knew which patients were getting acupuncture and which were not, which further means that there is no way to know if the measured effect was all placebo.

Still I read the study to analyze it more carefully. My fellow skeptical blogger, Orac, has already beaten me to the punch, however, in deconstructing this study. I will not, therefore, repeat what he has written. He correctly points out the major flaws in the study – that it is not blinded, there is no sham-acupuncture group, and it is not fully randomized. He also points out many of the minor flaws, such as not distinguishing among the various headache types, some self-selection in the non-randomized group, and the reliance on subject memory (rather than real-time diaries) for data collection. Read his entry for a more detailed discussion of these fatal flaws.

What I want to discuss in more detail here is the very fact that this study was done in the first place. What purpose did it fill?

A friend of mine recently sent me this link for the “color test.”I get this or a similar link every now and then. It is a fun little neurological game, and I am always intrigued by the pop-neuro explanations that come along with it.

Go ahead – take the test, then come back….

This color test is an old neuro-psychological test known as the Stroop test, and the effect is known as the Stroop Effect after John Ridley Stroop who first published about the effect in English in 1935. As is common, the effect was first described as a neuro-psychological phenomenon and then efforts were made to explain the effect as a consequence of neuroanatomy – how the brain is hardwired and how the different parts of the brain work together.

Here is another report of an outbreak of a preventable infectious disease in a population with low vaccination rates. This time it’s mumps in Canada in a religious community that believes getting vaccinated shows a lack of faith in the protection of God. I wonder if they feel it is blasphemy to wear a seatbelt, or use sunscreen, wash their hands, cook their food thoroughly, or do any of the common-sense things people should do to reduce their risk of infection or disease.

The report indicates:

There have been 116 confirmed cases of mumps and another 74 suspected cases since February, according to the Fraser Health Authority. On average, the region has only 10 cases a year.

Further, the cases of mumps are spreading outside of this community to the general population, including the city of Vancouver.

We are just seeing the tip of the iceberg if pockets of vaccine non-compliance continue to spread.

Homo neanderthalensis (Neanderthal Man) is our closest cousin, so our fascination with them is understandable. How closely related are we? How did we interact when we shared the planet up until 28,000 years ago? Who was more intelligent? Why are we still here and they are not?

Our image of Neanderthal Man also reflects, even encapsulates, our current ideas about evolution and our recent ancestors. Originally Neanderthal Man was visualized as brutish, hunched over, and dumb – the very icon of primitive (even still reflected in those Geico cave-man commercials). This image reflected our biases more than our science. Over time the facts slowly hammered our image into at least something more physicaly accurate: Neanderthal man was fully upright, they were not necessarily any more hairy than Homo sapiens (us), and they had a brain that was on average larger than modern humans.

But despite their larger brain size, which can reasonably be explained in part by their more robust physical stature, we still clung to our belief in Homo sapien superiority. After all, we are still here and they are not. We won.

Acupuncture is the practice of placing very thin needles through the skin in specific locations of the body for the purpose of healing and relief of symptoms. This practice is several thousand years old and is part of Traditional Chinese Medicine. As practiced today it is often combined with other interventions, such as sending a small current of electricity through the needles or burning herbs on the acupuncture points (a practice called moxibustion).

Acupuncture has recently been transplanted to the West, riding the wave of tolerance for unscientific treatment practices marketed as “complementary and alternative medicine.” While advocates have been successful at pushing acupuncture into the culture, the scientific medical community has still not accepted the practice as a legitimate scientific practice. I count myself among those extremely skeptical of acupuncture. I outline here the reasons for my continued skepticism.

The CDC yesterday updated their report on recent cases of measles. In 2000, thanks to the aggressive vaccination program, measles was declared eradicated from the US. There continued to be on average 63 cases per year from 2001-2007 due to imported cases from outside the US. To ironically quote Jim Carrey from the aptly titled, A Series of Unfortunate Events – “Then the unthinkable happened.”

The anti-vaccination movement was given a boost by actress Jenny McCarthy, who was convinced that vaccines were responsible for her son’s apparent autism. She was later joined in her crusade by her boyfriend, Jim Carrey. The movement had already been gaining some traction over false fears that thimerosal in vaccines (although mostly removed by 2002) was linked to autism. Such fears had already caused a drop in vaccination rates in the UK with subsequent measles outbreaks. Now these irrational fears were coming to the US, helped along by scientifically-illiterate pretty-people.

Due to the high-profile nonsense being spread by the antivaccinationists and the “mercury militia,” vaccination rates in the US have now dipped also (although not nearly as much as in the UK). Overall rates remain high, but there are pockets of low vaccination rates in communities where vaccine fears have spread. Such communities have dropped below the herd immunity level of vaccination and are susceptible to outbreaks.

Last week two Georgia boys, Matt Whitton and Rick Dyer, announced to the world that they had found the dead body of a bigfoot and had it in their freezer. They also said that they found the body at an undisclosed location where they also saw several other bigfeet scurrying off into the woos.

They promised a press conference where they would show their evidence. Skeptics responded with an appropriate level of skepticism – predicting that the press conference would yield no actual evidence as this was all an obvious hoax. Believers, like Cryptomundo, were breathless, declaring, “It certainly looks like the real deal.”

Last Friday they held their press conference and told the world about the evidence that they will provide in the future, but they did not present a body, compelling photographs, scientists who have examined the body or DNA evidence – nothing.

Though I agree there is a need to avoid ideological stances to influence decisions, it is important to INCLUDE them in decisions. We elect our politicians, form our lives and live our days based on our ideological views.

Also, it is frustrating to watch the debate of religious/ideological folks and the science folks. Both ends do need to be considered.

The ideological side has a right to state their views, as previously written, as we base so much of our lives on ideologies.

However, to question science is also important. The earth ain’t flat, you know. And if you don’t understand that statement, I really don’t want to hear from you.

Science, of course, needs to conduct itself regardless of ideological views, otherwise every test will be influenced one way or another.

There is a balance, and it must always be sought. If we attempt to say either side is unnecessary or impeachable, we are already lost.

I usually don’t like to pick on commenters and single them out, but as I Blog at Science Based Medicine on Wednesdays, rather than writing a long comment in response to mhowie I thought I would just make it my entry for today.

A recent study published in the Archives of Surgery combined a phone survey of random adults with a mail survey of doctors and nurses and looked at attitudes regarding death and dying from injuries. Here are the results summary from the abstract:

Most of the public and trauma professionals would prefer palliative care when doctors determine that aggressive critical care would not be beneficial in saving their lives. During resuscitation of an injured loved one, 51.9% of the public and 62.7% of the professionals would prefer to be in the emergency department treatment room. Most of the public believes that patients should have the right to demand care not recommended by their physicians. Most of both groups trust a doctor’s decision to withdraw treatment when futility is determined. More of the public (57.4%) than the professionals (19.5%) believe that divine intervention could save a person when physicians believe treatment is futile. Other findings suggest further important insights.

Surveys are always tricky to interpret because how the question is asked influences the answer. Also, answers may reflect hidden assumptions or concerns on the part of the respondent. Many surveys include mutually exclusive results – some individuals answering the questions had to give answers on some questions that directly contradicted each other. So clearly either some people did not understand the questions, or they were focusing on different implications of the different questions and did not recognize the contradiction.

This is my second entry discussing the issue of persistent vegetative state and Terri Schiavo. Actually it’s the third – the first was a review of a newly published study of the poor news coverage of the Schiavo case. In response Dr. Egnor wrote a blog entry (although he didn’t actually respond to any points I made in the post, it looks like he was just itching for an exchange on this issue), offering to discuss the relevant issues in our respective blogs. I wrote the first part of my response Friday, and here is part II.

In this entry I will review the medical facts of the Schiavo case, as best as I can reconstruct them. I was never directly involved with the case, I never examined her or reviewed original medical documents (except those made public, like the autopsy report). This is a minor problem, of course, as I must depend upon the examination of other neurologists. So to be clear I am not offering a direct medical opinion in this case – I cannot do that never having examined her myself – but rather an analysis of the public documents in the case.

To quickly review the medical history, Terri Schaivo collapsed at her home on February 25, 1990. Her husband, Michael, was home with her and immediately called EMS. Terri had a respiratory and cardiac arrest, although the exact cause of that arrest was never definitively determined. She was revived but suffered a diffuse anoxic injury (her brain had insufficient oxygen for a prolonged period of time) leading to extensive damage to her brain. For the next 15 years she was in a comatose state – a state of decreased consciousness and neurological function. Her case came to national attention over the controversy of her treatment. Her husband claimed that she had expressed the wish not to be kept alive in such a state. Her parents insisted that her religious views were such that she would want to be kept alive. Eventually her husband prevailed. Feeding and hydration were withdrawn and she passed away on March 31, 2005.